Provider Demographics
NPI:1689257479
Name:BRENNAN, SUSAN MARY (RN, BSN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 HOPEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1870
Mailing Address - Country:US
Mailing Address - Phone:703-597-7716
Mailing Address - Fax:
Practice Address - Street 1:4927 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2641
Practice Address - Country:US
Practice Address - Phone:301-943-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001163687163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant